Prevention of medical malpractice and disputes through analysis of lawsuits related to coronary angiography and intervention

Cheol Won Hyeon,Won Lee,So Yoon Kim,Ji Yong Park,Su Hwan Shin 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.3

Background/Aims: Possible fatal complications arising from coronary angiography (CAG), percutaneous coronary intervention (PCI), and coronary artery disease itself, are likely to cause medical disputes. Presenting the current status and reasons for judgments given in lawsuits related to CAG/PCI, this study aimed to identify ways to prevent unnecessary disputes and medical malpractice suits related to CAG/PCI through lawsuit analysis. Methods: A total of 13 cases (20 judgments) found in the Supreme Court of Korea’s Written Judgment Management System from 1998 to 2017 were analyzed. Results: Coronary artery injury was the most common causative complication that led to lawsuits (n = 6, 46%). Six cases (46%) were ruled in favor of the plaintiff for violation of duty of care (n = 4) and duty of explanation (n = 2), respectively. Cases that violated duty of care included two errors in intra-procedure device manipulation, one in pre-procedure diagnosis, and one in management of post-procedure complication. Lack of explanation regarding the risk of complications was pointed out in both cases that violated duty of explanation. The average awarded amount for the damages was 114,436,064 Korean won. Conclusions: Physicians need not fear unfair judgments so long as they follow standard of care because the Court consistently looked at the probability, the foreseeability, and the evidence. Therefore, maintaining standard of care is important. Besides, specific, detailed, and comprehensible explanations, including the risk of complications in addition to the necessity of procedures, are important to ensure the patient clearly understands the possible risk of adverse outcomes.

원통 연삭에서 가공 능률 향상을 위한 연삭 저항의 측정에 관한 연구

김원일,이진,이윤경,왕덕현,이상복,이관철,문원길 경남대학교 공업기술연구소 2000 硏究論文集 Vol.18 No.-

본 연구에서는 원통 연삭 가공에서 가공 능률 향상을 위한 연삭 저항을 측정하고자 연삭 가공 중에 발생하는 연삭 저항의 추이를 확인하였고 다음과 같은 결과를 얻었다. 숫돌과 공작물간의 연삭 강성은 공작 속도의 증가에 따라 지지계의 강성이 높은 경우 증가하였고 절삭 깊이와 연삭 숫돌의 속도에는 연삭 강성이 감소하는 경향을 보였다. 또한 총합 강성은 공작 속도, 절삭 깊이 및 연삭 숫돌의 속도 증가에 따라 지지계의 강성이 높을 수록 증가하였다. 연삭기의 강성 변형과 가공 능률에 영향을 주는 값으로 연삭 강성비는 지지계의 강성이 높을 수록 감소하였다. In this study, the measurement of grinding resistance to improve grinding efficiency in cylindrical grinding was studied and the following conclusions could be obtained. Relation grinding wheel and workpiece, grinding stiffness increases according to increase of work speed for high machine stiffness and decreases depth of cut and grinding wheel speed. Also, resultant stiffness increases high machine stiffness according to increase work speed, depth of cut and grinding wheel speed. The values of the effect stiffness deflection in grinding machine, grinding stiffness ratio decrease according to high machine stiffness.

원문 : 크레아틴-중탄산나트륨의 복합투여가 암-에르고미터 운동수행력에 미치는 영향

이철원 ( Cheol Won Lee ) 한국운동생리학회(구 한국운동과학회) 2014 운동과학 Vol.23 No.3

이철원. 크레아틴-중탄산나트륨의 복합투여가 암-에르고미터 운동수행력에 미치는 영향. 운동과학, 제23권 제3호. 257-266 2014. 본 연구는 크레아틴, 중탄산나트륨, 그리고 크레아틴과 중탄산나트륨의 복합투여가 암-에르고미터(arm-ergometer)를 이용한 상지 근기능에 미치는 효과를 알아보기 위해 경기도 소재 Y대학교 체육계열 남·여학생 17명을 대상으로 실시하였다. 무선추출법을 통해 크레아틴 투여집단(n=7), 중탄산나트륨 투여집단(n=5), 크레아틴과 중탄산나트륨의 복합투여집단(n=5), 총 3 집단으로 나누어 암-에르고미터를 이용한 상지 근기능 사전검사(pre-test) 후 집단별 로딩(loading)이 완료된 5일 후 사후검사(post-test)를 동일하게 실시하였다. 자료처리는 통계패키지 SPSS Ver. 12.0을 이용하여 모든 변인의 측정결과를 평균과 표준편차로 산출하고, 집단 및 시기 차이에 대한 주효과검정과 집단과 상호작용효과를 알아보기 위해 반복측정에 의한 이원변량분석 (Two-way repeated measured ANOVA)을 실시하였으며, 모든 통계적 유의수준은 p<.05로 설정하였다. 본 연구의 결과 암-에르고미터를 통한 검사 항목에서 최고 파워, 피로지수, 체중당 피크파워, 안정시 젖산농도 등에서 시기에 따른 유의한 차를 나타내었으나, 집단 간 유의한 차이는 나타나지 않았다. 결론적으로, 크레아틴과 중탄산나트륨 그리고 크레아틴과 중탄산나트륨의 복합투여는 암-에르고미터를 이용한 상지 운동수행력에 긍정적인 영향을 미치는 것으로 나타났으나, 복합투여의 우수성은 나타나지 않았다. Lee, Cheol-Won. The Effect of Combined Creatine and Sodium Bicarbonate Supplementation on Arm Ergometer Performance. Exercise Science. 23(3): 257-266, 2014. The purpose of this study was to assess the effects of creatine, sodium bicarbonate and combined creatine and sodium bicarbonate supplementation on upper limbs with arm-ergometer. Seventeen students majoring in physical education were randomly assigned to 3 groups [creatine (n=7), sodium bicarbonate (n=5), creatine & sodium bicarbonate (n=5)]. Pre-test consisted of muscular function of upper limbs with arm-ergometer and after 5 days later for creatine and sodium bicarbonate loading, post-test was processed with the same way as pre-test. Statistical analysis was performed by two-way repeated measured ANOVA for intervention. Significance was accepted at p<.05. The following results were obtained from this study. Peak power, fatigue index, peak power/kg and peak attainment time of arm-ergometer test were significantly (p<.05) increased by time but no difference among the groups. In conclusion, creatine, sodium bicarbonate and combined creatine & sodium bicarbonate supplementation favorably affected muscular function of upper limbs with arm-ergometer but there were no significant difference among the groups.

알레르기 환자에서 한방 이외의 대체 요법의 사용 현황에 대한 다기관 조사

이현정 ( Hyun Jung Lee ),이재현 ( Jae Hyun Lee ),이용원 ( Yong Won Lee ),김철우 ( Cheol Woo Kim ),동헌종 ( Hun Jong Dhong ),박해심 ( Hae Sim Park ),조영주 ( Young Joo Cho ),조진희 ( Jin Hee Cho ),조상헌 ( Sang Heon Cho ),편복양 ( 대한내과학회 2011 대한내과학회지 Vol.80 No.1

Background/Aims: The use of unproven complementary/alternative medicine (CAM) to treat allergies is popular in Korea. We conducted a multicenter survey of the current use of CAM other than herbal medication in Korean allergy patients. Methods: This study enrolled 510 adults with allergic diseases, including asthma, allergic rhinitis, atopic dermatitis, and chronic urticaria, from ten hospitals. They underwent a structured questionnaire interview and clinical assessment of the prevalence, motivation, costs, and subjective assessment of CAM. Results: Of the patients, 16.7% used at least one type of CAM to treat their allergic diseases. Common types of CAM were diet (48.6%), aroma therapy (23.8%), massage (14.3%), breathing exercises (7.6%), baths (5.7%), and mind control (5.7%). The therapeutic effects of CAM included improved in patients using mind control (50%), diet (50%), breathing exercises (75%), and baths (33.3%), but worse in patients using aroma therapy (28%), and massage (26.7%). About 36.4% of the patients used CAM more than four times per year, and the average cost per CAM user was 370,000 won/year. The main reason for trying CAM was `hope to improve my constitution`. Conclusions: CAM is used widely for treating allergic diseases in Korea. Detailed knowledge of CAM and patient education are important. Further studies of the clinical efficacy of CAM are needed. (Korean J Med 2011;80:68-77)

소음인(少陰人) 태음병(太陰病) 심하비증(心下?證)의 병증약리(病證藥理) 고찰

서영광,이지원,이준희,최원철,이의주,고병희,Seo, Young-Kwang,Lee, Ji-Won,Lee, Jun-Hee,Choi, Won-Cheol,Lee, Eui-Ju,Kho, Byung-Hee 사상체질의학회 2010 사상체질의학회지 Vol.22 No.3

1. Objective: Gastric Stuffiness (心下?證) in the Soeumin Taeeum symptomatology (少陰人 太陰病) in Sasang Constitutional Medicine shows an interesting evolutionary process. Originally found in the texts of Sanghanlun (傷寒論), the perspectives regarding the symptoms of Gastric Stuffiness were expanded by many medical scholars and Lee Jema. To comprehend the Jema's concept of Taeeum symptomatology and utilize his prescription clinically, it deserves to study on the Gastric Stuffiness in Donguisuseowon (東醫壽世保元). 2. Methods: Many texts including Sanghanlun (傷寒論) and Dongeuibogam (東醫寶鑑) were reviewed in order to track the evolutionary process concerning the symptoms of Gastric Stuffiness. Also, Lee Jema's works including the different versions of Donguisuseowon (東醫壽世保元) were reviewed to examine the development of Lee's concepts regarding the Gastric Stuffiness in the Soeumin Taeeum symptomatology. 3. Results and Conclusions: 1) Most of the previous concepts on Gastric Stuffiness were generally similar to those found in Sanghanlun, especially in that they addressed Yang deficiency of the middle triple energizeer as the central pathogenic process. 2) Lee Jema's views on the epigastric discomfort in the Soeumin Taeeum symptomatology evoloved over time and culminated in the finalized pathology and therapeutics appearing in his last work, the Shinchuk version of Donguisuseowon (東醫壽世保元). 3) 4 kinds of prescription which invented by Lee Jema to treat the Gastric Stuffiness in the Soeumin Taeeum symptomatology can be matched to the prescription of Sanghanlun respectively. However through evolutionary process of Jema's prescriptions, the indication of them expanded: not only to treat Gastric Stuffiness but to diverse symptoms of Soeumin.

부산·울산·경남지역 직업병 감시체계

김정일,김병권,김정원,채창호,이철호,강동묵,김지홍,김진하,김영욱,이영하,이지호,김정호,윤형렬,유철인,정백근,장태원,김운규,윤동영,강진욱,김종은,안진홍,이동준,장준호,이광영,송혜란,최영희,이용환,조병만,최홍렬,고상백,김은아,이유진,홍영습,정갑열,김정만,김준연 大韓産業醫學會 2004 대한직업환경의학회지 Vol.16 No.1

Objective: Occupational medicine specialists in the Busan, Ulsan and Kyung-Nam areas established an area-based occupational disease surveillance system and used this system to collected case information for the purpose of preventing occupational diseases Methods: l l hospital participated in this system. The authors selected five main diseases, which were hand-arm vibration syndrome (HAVS), work-related musculoskeletal disorder (WRMSD), occupational asthma, occupational skin disease and occupational and occupational lung cancer and established their case definitions. All cases were reported on the web, and real time analysis was conducted. Results: Between April 2001 and April 2003, 192 cases of HAVS, 118 cases of WRMSD, 33 cases of occupational asthma, 17 cases of occupational skin disease and 17 cases of occupational lung cancer (for a total of 377 cases of these five main diseases) were reported. most of the HAVS cases came from shipbuilding, and 172 of them (92.7%) were associated with grinding. Of the four main types of WRMSD, carpal tunnel syndrome (CTS) was the most prevalent with 46 cases and shipbuilding was also the main industry involved (83.9%). The ergonomic risk factors involved mainly associated with the hand. In 19 (57.6%) and 4 (12.1%) cases of occupational asthma, the agents involved. The causative agents of occupational lung cancer included Cr, welding fume, PAH, Ni, etc. 10(58.8%) of the cases were diagnosed as squamous cell carcinoma and 5(29.4%) as adenoma. Conclusion: This result showed that an area-based occupational disease surveillance system might provide an effective method of evaluating the prevalence of such diseases, however the Busan, Ulsan and Kyung-Nam provinces are too large to be treated as individual areas. Therefore, the authors suggest that each province should establish its own surveillance system.

외상성 뇌손상환자의 MMPI Profile예 따른 정신과적 증상

이원희,박민철,오상우,박종호 圓光大學校 醫科學硏究所 1997 圓光醫科學 Vol.13 No.1-2

This study was to investigate psychiatric symptoms of patients with traumatic brain injury in the MMPI profile. 88 patients with traumatic brain injury and 45 normal persons were underwent the MMPI and SCL-90-R. The results were as follows. 1) The MMPI profile of patients with traumatic brain injury were different from normal persons. 2) Traumatic brain injury patients were divided into neurotic profile and psychotic profile groups in the MMPI. 3) Group with psychotic profile of traumatic brain injury in the MMPI showed elevated paranoid ideation and psychoticism subscales of SCL-90-R. 4) Group with neurotic profile of traumatic brain injury in MMPI showed an elevated somatization subscale of SCL-90-R. 5) In the scores of GSI and PSDI of the SCL-90-R, group with neurotic profile of traumatic brain injury in the MMPI were higher than normal persons, but lower than the group with psychotic profile of head trauma. Finally, this study of the MMPI profile of traumatic brain injury showed 7-8-6-2 profile and 1-3-2 profile. The group showing 7-8-6-2 profile presented both psychotic and neurotic symptoms and 1-3-2 profile showed an elevated somatization subscale.

근대 중국경제와 홍콩-상하이은행(HSBC)의 성장

이철원 韓國外國語大學校 外國學綜合硏究센터 歷史文化硏究所 2000 역사문화연구 Vol.11 No.-

사지의 주요 동맥손상의 처치: 23증례에 대한 분석

원형섭,김상은,배성만,박철완,이 근,조상훈,김상일,우병완 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Extremity vascular trauma is common in most emergency centers, and controversy remains about the optimal management of arterial injuries. Retrospectively we reviewed the records of 23 patients who had upper or lower extremity arterial trauma from July 1994 to December 1995. The purpose of this study was to evaluate our department`s management policy to major arterial injuries. The leading cause of major arterial injuries was penetrating trauma. We found that there were clinical findings such as absence of or decreased strength of pulsation(82.6%), cool ischemic extremity(69.6%), large expanding hematoma(43.5%), major bleeding(17.4%) and bruit or thill(8.7%). We gave the priority to management of life-threatening injuries and applied the pressure dressing to wounds as early as possible. There were 18 men(78.3%) and 5 women(21.7%); the mean age was 35(range 20-56 years old) years. There were 12 arterial injuries(52.2%) in the upper extremity and 11 arterial injuries(47.8%) in the lower exteremity. The most commonly injured artery was the brachial artery in the upper(34.8%) and the femoral artery in the lower(30.4%) extremity. The etiology included knife stabbing in 10 patients(43.5%), motor vehicle accidents in 6(26.1%), industrial accidents in 4(17.4%), falls in 2(8.7%) and a farm equipment accident in 1 patient(4.3%). The associated injuries were muscle injuries(78.3%), fracture(56.5%), nerve injuries(52.2%), vein injuries(43.5%), shock(17.4%) and dislocation(13.0%). All patients with arterial injuries were given a preoperative prophylactic antibiotic and TIG(tetanus immunoglobulin). We used Doppler technique as a means of detecting the blood flow. Fourteen patients(60.9%) underwent preoperative arteriography in the radiology department. We performed surgical exploration as soon as major arterial injuries were suspected. The most common methods of treating major arterial injuries were interposition vein graft(69.6%) and end to end anastomosis(21.7%). Systemic or locally infused heparin was used for all vascular repairs. In many of our patients(56.5%), fasciotomy was performed before the vascular repair, as a part of the exploration of the distal arteries. There were 2 amputations(8.7%) but no death. The reason for secondary amputation were wound infection in one and failure to achieve sufficient arterial flow to the involved extremity with resulting gangrene in the other. As the time factor is vitally important in the management of arterial injuries, we advocate prompt and early surgical treatment within 6 hours of the trauma. In conclusion, we believe that the crucial factorsin successful management of major arterial injuries of the extremities are early diagnosis, prompt treatment, complete debridement, fasciotomy when indicated, and simultaneous treatment of concomitant injuries.

구개편도에 발생한 결핵

이병돈,강주원,장혁순,박철규,김장묵 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.1

Tonsillar tuberculosis, almost always secondary to pulmonary tuberculosis is very rare disease in otolaryngologic fields. Authors have experienced a case of tonsillar tuberculosis associated with miliary pulmonary tuberculosis. The patient had cough, sputum and sore throat for 1 month. On physical examinations, palatine tonsils were slightly hypertrophied, smoothly surfaced, but crypt ulceration or patches were not seen. Diffuse discrete nodules were seen in both lung fields by simple chest X-ray. In high resolution computed tomography, miliary tuberculosis was suspected and in pleural needle biopsy, granulomatous inflammaiton was diagnosed as tuberculosis. AFB smear of sputum was two positive. Histopatholoigic finding of right tonsil was consistent with tuberculosis. He was cured of it with antituberculosis medications for one year. We report the case with review of the literatures.